Standards of antimicrobial prescribing for prophylaxis in selected surgical operations: A study conducted in a teaching hospital.

A study of the prescribing habits of the surgeons of Fremantle Hospital for antimicrobial prophylaxis was conducted in the period from July to October, 1979. In selected operations, an assessment of use was made according to generally accepted principles of prophylaxis. In 109 "clean" surgical operations and in 38 cholecystectomies, antimicrobial agents were rarely used for prophylaxis. It was concluded that there was no overusage of prophylactic antimicrobial agents in surgery. In 58 operations on the appendix and large bowel, it was found that administration of the antimicrobial agents was started either too late or the choice of agent was illogical in 15 cases. In 12 total hip replacements, the prescribing was satisfactory, but, in 21 Richards' pin-and-plate operations and in 35 minor orthopaedic implants, prophylaxis was continued for longer than 48 hours in 33 of 41 courses of therapy. The mean duration of a course was 6.5 days for pin-and plate and 6.7 days for minor implants. In only seven of 30 hysterectomies were patients covered for Bacteroides fragilis infection at the time of operation, the mean duration of a course was 5.5 days. It is suggested that a reduction in costs and increase in quality of care are most likely to be achieved by surgical teams adopting a protocol in operations where prophylaxis is of proven value.